Experience with a metered-dose inhaler with a spacer in the pediatric emergency department
G. Benton, R. C. Thomas, B. G. Nickerson, J. C. McQuitty and J. Okikawa
Childrens Hospital Medical Center, Oakland, CA 94609.
Studies of adults suggest that metered-dose inhalers with spacers are as
effective as hand-held nebulizers for bronchodilator delivery. We studied
13 children with acute asthma. They received two puffs every 2 minutes from
metered-dose inhalers with spacers (range, 4 to 14 puffs) titrated until
improvement stopped. Peak expiratory flow increased 34% for metered-dose
inhalers with spacers after the first 2 puffs and increased 87% for
metered-dose inhalers with spacers after dose titration. After titration,
respiratory rate decreased by 12%, heart rate increased by 2%, and breath
sounds improved in 92% of the patients. We concluded that the metered-dose
inhalers with spacers are an effective device for the treatment of asthma
in the pediatric emergency department and that the use of metered-dose
inhalers with spacers with titration can achieve significant
bronchodilation in the treatment of patients with acute asthma.
